Sex and the menopause

How does the menopause affect sex drive?

The loss of oestrogen following the menopause can lead to changes in a woman's sexual drive and functioning. Menopausal and postmenopausal women may notice that they are not as easily aroused, and may be less sensitive to touching and stroking - which can result in decreased interest in sex.

In addition, lower levels of oestrogen can cause a decrease in blood supply to the vagina. This decreased blood flow can affect vaginal lubrication, causing the vagina to be too dry for comfortable intercourse.

A lower oestrogen level is not the only culprit behind a decreased libido; there are numerous other factors that may influence a woman's interest in sexual activity during the menopause and after. These include:

Does the menopause lower sex drive in all women?

No. In fact, some post-menopausal women report an increase in sex drive. This may be due to decreased anxiety associated with a fear of pregnancy. In addition, many post-menopausal women often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.

What can I do to treat vaginal dryness during menopause?

During and after the menopause, vaginal dryness can be treated with a water-soluble personal lubricant. Do not use non-water soluble lubricants such as petroleum jelly because they can weaken latex (the material used to make condoms, which should continue to be used to avoid pregnancy until you confirm you have reached the menopause and to prevent contracting sexually transmitted infections). Non-water soluble lubricants can also provide a medium for bacterial growth, particularly in a person whose immune system has been weakened by chemotherapy.

How can I improve my sex drive during and after the menopause?

Currently, there are not any drugs reliably proven to treat a reduced sex drive in women dealing with the menopause. Oestrogen replacement may work, but research has yielded conflicting results regarding its effectiveness. Oestrogen can, however, make intercourse less painful by treating vaginal dryness.

Doctors are also studying whether a combination of oestrogen and the male hormones, called androgens, may be helpful in increasing sex drive in women.

Although sexual problems can be difficult to discuss, talk to your doctor; there are options to consider, such as counselling. Your doctor may refer you and your partner to a health professional who specialises in sexual dysfunction. The therapist may advise sexual counselling on an individual basis, with your partner or in a support group. This type of counselling can be very successful, even when it is done on a short-term basis.

How can I increase intimacy with my partner during the menopause?

During the menopause, if your sex drive isn't what it once was but you don't think you need counselling, you should still take time for intimacy with your partner. Being intimate does not require having intercourse - love and affection can be expressed in many ways. Enjoy your time together - you can take long romantic walks, have candlelit dinners, or give each other back massages.

To improve your physical intimacy, you may want to try the following approaches:

Educate yourself about your anatomy, sexual function, and the normal changes associated with ageing, as well as sexual behaviour and responses. This may help you overcome your anxieties about sexual function and performance.

Enhance stimulation through the use of erotic materials (videos or books) masturbation and changes to sexual routines.

Use distraction techniques to increase relaxation and eliminate anxiety. These can include erotic or non-erotic fantasies; exercises with intercourse; and music, videos or television.

Practise non-coital behaviour (physically stimulating activity that does not include intercourse), such as sensual massage. These activities can be used to promote comfort and increase communication between you and your partner.

Minimise any pain you may be experiencing by using sexual positions that allow you to control the depth of penetration. You may also want to have a warm bath before intercourse to help you relax, and use vaginal lubricants to help reduce pain caused by friction.

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